Doctors' fear of multi-million dollar lawsuits is pushing them to practice "defensive medicine." More doctors are ordering additional tests and procedures not based on need but fear of liability.

The government estimates that cost of medical malpractice is less than 2% of overall health care spending. Industry experts say defensive medicine accounts for about 10% of health care costs, or more than $100 billion annually.

What's in the law: The legislation doesn't impose a cap on damages from lawsuits. Instead, the law authorizes the Secretary of Health & Human Services to award five-year grantsto states to test alternatives to lawsuits, including health courts and early disclosure laws.

A timely apology is all families usually want, experts say. Disclosure laws would allow doctors to apologize for errors and resolve any dispute without going to court. However experts say that apology could be admissible in any future lawsuit.

Medicare threatens to cut my pay every year

Every year, doctors say their cost of doing business is rising much faster than what Medicare pays them. In fact, they say, payments have been falling.

According to the law, a Federally mandated formula is used every year to determine payment rates based on the health of the economy. Payment rates have been cut for the past 8 years, although Congress has stepped in each year except for one to block them. This year, a 21% pay cut has gone into effect and Congress has yet to block it.

Faced with these cuts, doctors say they could stop accepting new Medicare patients or even drop existing ones.

Medicare is a federally funded program that provides health insurance for about 45 million Americans age 65 or older.

What's in the law: The legislation does not provide for a permanent solution to the threat of yearly Medicare pay cuts.

Pay raise not enough

Doctors say new bonuses mandated by the legislation are a welcome benefit but fear they could be offset by other measures.

What's in the law: Beginning in 2011 and in effect until 2016, the law established a 10% Medicare bonus payment to care providers who bill at least 60% of their charges for primary care services.

General surgeons also get a 10% Medicare bonus payment beginning in 2011 until 2016 if they practice in underserved areas.

Also, beginning 2013 and through 2014, Medicaid payments for all primary care service (which tend to be much less than what Medicare pays for comparable services) will be brought up to equal Medicare payment rates for those services.

Medicaid, a jointly funded Federal and state program, provides insurance for about 44 million low-income people, including children and pregnant women.

Still, one physician says the bonuses aren't enough.

"As a rural family physician in Nebraska, 10% appears to be a nice increase, but it hardly offsets the increasing amount of administrative nightmares," said Dr. Brandon Essink, a primary care physician.

Another doctor fears the removal of co-pays will hurt his income.

Beginning in 2011, the legislation eliminates co-payments and co-insurance for preventive services and exempts preventive services from deductibles under the Medicare program.

"Co-pays for health-maintenance visits are sometimes the only cash flow a practice can have," said Dr. Paul Willis, a primary care physician.

Still drowning in school debt

Medical school debt ranges from $120,000 to $150,000, on average.

Faced with such a sizeable debt, more graduates are shunning low-paying specialties such as primary care in favor of higher paying specialties.

That trend has resulted in a shortage of primary care doctors in the United States.

Stephen Carey, a student at the Philadelphia College of Osteopathic Medicine, isn't sure that the legislation does enough to help him out.

"[The bill] does not do enough to address the fact that debt still is one of the limiting factors in deciding what and where to practice as physicians," said Carey.

What's in the law: The legislation sets aside $125 million for scholarships and other financial assistance in 2010. For 2011 through 2014 hospitals and other institutions will get money to boost their primary care training programs, but how much is unknown.

Other measures include increasing medical and nursing student loans and loan forgiveness to new physicians who agree to practice in health care shortage areas.

While health reform tries to place doctors where they're needed and attract more medical students, industry insiders say that it has ignored a critical aspect of medical training -- residency slots.

Medicare currently funds about one-third of the costs of all residency programs and froze its funding in 1997.

The number of medical students is increasing, and the concern is that unless Medicare lifts its cap on residency funding in the near future, there will be more students in the system than there are residency slots to train them to become practicing physicians, said Dr. Atul Grover, the Association of American Medical Colleges' chief advocacy officer.

Insurers still meddling in my work

Many insurers now require "prior authorization" from doctors for expensive procedures such as MRIs and CAT scans. This means that your doctor has to call the insurance company in advance to explain why the tests are needed.

The insurer may or may not approve the procedure, in which case the patient can either forego it or pay out of pocket.

What's in the law: The legislation does not address prior authorizations.

"The preauthorization issue was not out of the realm of issues that the legislation could have addressed," said Dr. Lori Heim, president of the American Academy of Family Physicians.

"I would presume that it was insurers that did not want the government to be involved in this issue because those insurer preauthorizations are a way for them to keep their own costs down," Heim said.